Medicaid Proposes Coverage Policy for Adults

The state Medicaid department recently published the first major proposal on the upcoming adult dental benefit. The current policy coverage standard can be accessed by clicking here.

A draft coverage policy was shared with Take 5 participants in January for feedback. It was finalized late last week. The policy includes information on coverage for diagnostic procedures, x-rays, preventive procedures, minor and major restorative procedures, endodontic procedures, periodontal treatment, removable prosthetics, oral surgery and anesthesia, as well as policies on non-covered services, prior authorizations and billing guidelines that will apply to adults covered by Medicaid. The document lists code descriptions for procedures and any frequency limitations or prior authorizations required.

Based on feedback from Take 5 participating dentists, the CDA submitted comments to the state Medicaid department to ask for clarification on aspects of the policy, including the annual maximum, crown allowances, prosthodontic codes and more. If you have feedback on the final coverage standard, please e-mail your comments to jennifer@cdaonline.org.